Arizona’s population grew by 25 percent between 2000 and 2010, and the influx continues. If you are considering a move to The Grand Canyon State, or if you already live there, you’re likely interested in factors that impact the overall health of the state’s residents, including Medicaid expansion and the Affordable Care Act.
We’ve put together a partial list of those factors for your consideration.
How Arizona ranks among the states
Arizona is rated 36th by the Scorecard on State Health System Performance 2014, which compares the 50 states and the District of Columbia. Arizona climbed four spots from its ranking in 2009; however, the state fell into the bottom five for five health indicators including uninsured children, adults ages 50 and older who received recommended screening and preventive care, children with a medical home, obesity in children ages 10 to 17, and home health patients whose wounds improved or healed after an operation. Visit the Arizona Scorecard to see the factors that contribute to the state’s overall “healthiness” rating.
Arizona lands a bit higher on America’s Health Rankings for 2014, earning the 29th spot – one spot lower than 29th in 2013. While binge drinking and preventable hospitalization rates decreased in the past two years, chlamydia and obesity rates increased. The state also faces challenges when it comes to public health funding, disparity in health status, access to primary care physicians and lack of health insurance.
Visit Key Health Data About Arizona to see how Arizona ranks on additional health indicators, public health readiness measures, and public health funding indicators.
Health status can vary significantly across a state. For a more focused look, review county-by-county ratings for Arizona; this data comes from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Arizona and the Affordable Care Act
In voting on the Affordable Care Act, Sens. John McCain and Jon Kyl voted no. Arizona’s eight representatives split their votes along party lines: the four Democrats voted yes, while the four Republicans voted no. The ACA was signed into law in March 2010.
Former Arizona Gov. Jan Brewer, a Republican, was vocally opposed to the Affordable Care Act, even calling a special legislative session in 2010 to advance her position. Brewer wanted permission to join the lawsuit challenging the healthcare reform law after the state’s Democratic attorney general refused to join the suit.
In the 2010 election, Arizona voters approved a state constitutional amendment barring any rules or regulations that would force state residents to participate in a healthcare system.
Despite opposing the overall ACA, Brewer was in favor of state-run health insurance exchange and said it was preferable to a one-size-fits-all model imposed by the federal government. To that end, Brewer established the Office of Health Insurance Exchange, and the state took numerous steps toward setting up a state-run exchange. However, state legislators and a public majority remaining opposed. Brewer ultimately bowed to public sentiment and defaulted to the federally facilitated marketplace. The state did opt to expand Medicaid under the Affordable Care Act.
Doug Ducey, a Republican, took over the governor’s office in January 2015. During his campaign, he described himself as “100 percent opposed to Obamacare.”
How has Obamacare helped Arizona’s uninsured?
Depending on the study, Arizona saw a somewhere between a 2.9 percent and 3.74 percent drop in its uninsured rate over the course of the 2014 open enrollment period, falling to somewhere between 16.38 and 17.5 percent.
By mid-2015, Gallup showed Arizona’s uninsured rate to be at 14.3 percent – down 5.9 percentage points from 2013, before Obamacare’s individual mandate took effect. In other states that only expanded Medicaid, only created a state/partnership exchange, or did neither, the uninsured rate by mid-2015 was 13.4 percent and had fallen 5.3 percentage points since 2013. In 2015, the national uninsured rate was 11.7 percent.
Arizonans enrollment in qualified health plans
Research by the Kaiser Family Foundation estimated Arizona’s potential market for the health insurance exchange at 551,000 and estimated that 313,000 of those potential consumers would qualify for tax subsidies. Actual results from the 2014 open enrollment period showed that 120,071 people signed up for qualified health plans (QHPs) through Arizona’s health insurance exchange and 144,376 qualified for financial assistance.
During 2015 open enrollment many more enrolled in private health plans through Arizona’s federally facilitated exchange. Of the 205,666 individuals that selected a QHP, 48 percent were new to the exchange. As happens in every state, some people failed to make their initial premium payments or canceled their coverage, and effectuated enrollment stood at 154,121 by June 30. Of those remaining, 76 percent were in plans with advanced premium tax credits and 54 percent were receiving cost-sharing subsidies with their silver plans.
With the arrival of 2016 open enrollment, Arizonans saw changes to the health insurance marketplace. For starters, Meritus, the state’s Consumer Operated and Oriented Plan (CO-OP, announced on October 30, 2015, that it would cease operations at year-end. Meritus is among 12 CO-OPs that had folded by early November and will not offer 2016 coverage.
Consumers will also notice fewer PPO plans available for 2016. Aetna, Cigna and Blue Cross Blue Shield of Arizona will only sell HMO plans on the state’s exchange, and those currently enrolled in these carriers’ PPO plans will be re-enrolled in the most similar HMP plan available or may shop around for different coverage.
AZ exchange carriers for 2016
In total, 8 carriers will sell 2016 plans through the Arizona health insurance exchange:
- Blue Cross Blue Shield of Arizona
- Health Choice
- Health Net Life Insurance (PPO) and Health Net of Arizona (HMO)
- Phoenix Health Plans
- UnitedHealthcare (All Savers)
Three carriers that offered 2015 plans through Arizona’s health insurance exchange will not offer 2016 coverage: Time Insurance Co., whose parent company, Assurant, announced it would exit the individual market nationwide at the end of 2015; the state’s CO-OP, Meritus, which will cease operations at year-end; and the University of Arizona Health Plans.
With rate increases and changes in carrier and plan options, consumers are strongly encouraged to shop around for coverage.
Medicaid in Arizona
Former Gov. Brewer followed a different course than most Republican governors and pushed hard for Medicaid expansion in Arizona. A bill authorizing expansion was passed with some Republican support and signed into law by Brewer in 2013.
However, the expansion has been repeatedly challenged. In December 2014, the Arizona Supreme Court ruled that a lawsuit, brought by the Goldwater Institute and 36 state Republicans, challenging Medicaid expansion could proceed. The conservatives say that legislation for funding expansion was not approved by the supermajority required for tax measures. The state maintains that the funding mechanism is an assessment, not a tax, and therefore only a simple majority is required.
With Arizona Medicaid expansion in place for now, 58 percent of uninsured nonelderly people in Arizona are eligible for financial assistance to gain medical insurance coverage through either Medicaid or the marketplace. Forty-two percent of those currently uninsured are not eligible due to immigration status, and another 21 percent are ineligible because their incomes are too high or because they have access to affordable coverage through an employer.
Arizona has seen a 36 percent increase in monthly Medicaid enrollment from 2013 to August 2015, the 12th largest change nationwide.
Learn more about Arizona’s Medicaid program at the Arizona Health Care Cost Containment System website.
Arizona health reform legislation
Here’s what’s happening legislatively with healthcare reform at the state level in Arizona:
The Arizona legislature in February 2015 passed SB1092, which requires the state to seek an annual waiver from CMS to allow additional Medicaid eligibility restrictions. Gov. Ducey signed the bill into law in March. As of October 2015, CMS was reviewing the 2015 waiver proposal.
Gov. Ducey signed HB2643 into law in April 2015. The legislation effectively bans the state from creating a state-run exchange.
Medicare enrollment in the state of Arizona
Arizona Medicare enrollment reached 1.118 million in 2015, nearly 17 percent of the state’s population. Seventeen percent of the U.S. population is enrolled in Medicare. Eighty-three percent of Arizona’s Medicare beneficiaries qualify based on age alone, while the remaining 17 percent are on Medicare as the result of a disability.
Medicare pays about $9,395 per Arizona enrollee each year, and the state ranks 18th in overall Medicare spending with $8.5 billion annually.
Arizona Medicare recipients who want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead, and nearly 39 percent make this choice. Thirty-two percent of Medicare beneficiaries nationwide are enrolled in Medicare Advantage plans.
Thirty-four percent of Arizona Medicare beneficiaries are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage. Forty-three percent of all Medicare enrollees have Medicare Part D plans.